Induction with remimazolam (Byfavo) for patients undergoing laparoscopic gastrointestinal surgery may reduce post-operative delirium compared with propofol

1. In this randomized controlled trial, elderly patients who received remimazolam (Byfavo) prior to undergoing elective laparoscopic gastrointestinal surgery had reduced post-operative delirium compared with those induced with propofol.

Evidence Rating Level: 1 (Excellent)

Postoperative delirium is a common complication among elderly patients following surgery. Often, residual effects of anesthetic medications may alter patients’ level of consciousness and have higher rates of confusion, injury, and prolonged recovery. In this prospective trial, 186 patients aged 60-80 years were randomized to be anesthetically induced with either remimazolam, a short-acting benzodiazepine or propofol, which is often the standard induction agent. The incidence of postoperative delirium was 12.9% in the group that received higher doses of remimazolam, 11.3% in the group that received a low dose of remimazolam, and 6.5% in the propofol control group (p=0.467). While remimazolam did not improve postoperative delirium, it did exhibit a higher mean arterial pressure following induction and intubation compared to propofol (p<0.05). In addition, remimazolam was associated with a lower rate of bradycardic events (p<0.001) and lower vasopressor requirements intraoperatively (p<0.05). Overall, this study proved that the use of short-acting benzodiazepines as an alternative to propofol for anesthetic induction prior to elective laparoscopic surgery improved intraoperative cardiovascular events; however, it did not reduce postoperative delirium in elderly patients. 

Click here to read this study in Frontiers in Medicine

Citation: Fan H, Chen X, Xu L, Zou B, Li D, Zhang C, et al. Remimazolam versus propofol for elderly patients undergoing laparoscopic gastrointestinal surgery: a randomized trial concentrating on delirium and hemodynamic stability. Front Med (Lausanne). 2026 Oct 16;13:1992969. doi: 10.3389/fmed.2026.1992969.

© 2026 2 Minute Medicine, Inc. All rights reserved. No part of this article may be reproduced, distributed or transmitted in any form or by any means without the prior written permission of 2 Minute Medicine, Inc. To license this content, contact 2 Minute Medicine, Inc. This article is for informational and educational purposes only; it is not medical advice and does not replace the judgment of a qualified healthcare professional.
Image: © 2 Minute Medicine